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Your period — or more specifically, the stopping of it — isn’t the only thing that changes after you go through menopause. The higher hormone levels that keep your menstrual cycle regular have additional roles in the body. Without the protective effects of the hormones, especially estrogen, women face new health challenges.

“Postmenopausal women are unique in that their health risks increase not just due to age but also due to the loss of estrogen,” says JoAnn Pinkerton, MD, the executive director of the North American Menopause Society (NAMS) and a professor of obstetrics and gynecology at the University of Virginia Health System.

When Are You Postmenopausal?

Menopause is diagnosed after the fact, once you have gone a full year without a single period, Dr. Pinkerton says. Before that, you might skip a cycle or have periods spread out farther than usual. During this phase, you are in perimenopause, not menopause.

During perimenopause, the amount of estrogen in your body fluctuates wildly. Once you are menopausal, however, this hormone drops to a very low level and stays there, according to NAMS.

New Health Risks Emerge as Estrogen Level Declines

Women who have no health issues before menopause face increased odds of problems after going through the change.

While every woman faces a unique risk based on genetics and other factors, it is important to be extra vigilant with these four commonly troublesome concerns.

1. Heart Disease Risk Jumps at Midlife

Women often think breast cancer is their biggest killer, but the biggest danger after menopause is actually heart disease. Nearly a third of women develop cardiovascular disease, the AHA says. The rate of heart attacks in women begins increasing roughly a decade after menopause.

A key reason is that estrogen helps keep blood vessels flexible, so they contract and expand to accommodate blood flow. Once estrogen diminishes, this benefit is lost. Coupled with the other changes, like the rise in blood pressure, which can thicken artery walls, women’s hearts suddenly become vulnerable.

Reduce the Heart Disease Risk Factors That You Can

Your family history influences your risk, and it is something you cannot control. But your overall risk can be lowered by following a heart-healthy lifestyle. This includes eating a diet high in vegetables and low in red meat and sugar, exercising 150 minutes or more each week, and quitting smoking if you do.

The AHA also encourages women to know their blood pressure, cholesterol and blood sugar levels, and body mass index (BMI). Plugging these numbers into the ASCVD risk calculator, introduced in 2013 by the American Heart Association and the American College of Cardiology, can help you assess your 10-year heart disease risk.

Even though estrogen protects the heart, taking postmenopausal hormone therapy has not been shown to be effective in reducing the risk of heart disease, the AHA cautions.

Osteoporosis Symptoms Can Be Invisible

You may not even notice that your bones are weakening, as osteoporosis may not cause symptoms for decades. A bone fracture can be the first sign of the disease. This is why women 65 and older are urged to get the bone mineral density test known DXA or DEXA (for dual-energy X-ray absorptiometry), which measures bone thickness in the spine, hips, hands, heels, and wrists.

Osteoporosis Screenings and Testing You May Need

If you are postmenopausal and have other risk factors, including rheumatoid arthritis, a parent’s history of a hip fracture, smoking, alcoholism, or a low BMI, talk to your doctor about having a DXA test before 65.

You can also use an online tool called FRAX to estimate your fracture risk in the next 10 years. This takes into account your age, gender, BMI, smoking, alcohol intake, certain medications, and other risk factors.

How to Boost Bone Health in Midlife

To keep your bones strong, make sure some of your exercise routine is weight bearing, which is when your bones work against gravity, such as brisk walking or jogging. Don’t smoke. And eat a healthy diet including foods high in calcium (dark leafy greens, dairy, and canned fish such as salmon and sardines) and vitamin D (fortified orange juice, cereal, and milk, or from 15 minutes of sun exposure several days a week).

3. Urinary Incontinence Bothers Many Women at Midlife

The most common type is stress urinary incontinence, when coughing, sneezing, or physical activity causes leakage. Urgency incontinence happens when leakage is accompanied by an uncontrollable urge to get to the bathroom immediately. Many women have a mix of the two.

This occurs because the tissues of the bladder and urethra (the tube where urine flows from the bladder) contain estrogen and pro­gesterone receptors and are thickened by the hormones. Once the hormone levels drop, the tissue thins and weakens. In addition, the muscles around the pelvis may lose tone with aging, a process known as "pelvic relaxation."

To prevent urinary incontinence, empty your bladder as often as possible. And do Kegel exercises, contracting and relaxing the muscles of the pelvic floor. The key to proper Kegels is to work the subtle muscles controlling the stream of urine (rather than the butt muscles). Hold each contraction for two to three seconds, building up to five sets of 10 repetitions per day, according to NAMS. If problems persist, talk to your doctor or seek out a physical therapist with expertise in working the pelvic floor.

4. Midlife Weight Gain: It’s Easy to Pack on Pounds After Menopause

In the seminal menopause study known as SWAN, almost 30 percent of women going through the change gained 5 percent or more of their body weight in just six years. Even women who maintain the same diet and exercise routine can pack on pounds in midlife, writesStephanie Faubion, MD, a women’s health physician at the Mayo Clinic and a NAMS board member.

Why Fat Migrates to a Woman’s Midsection at Midlife

Part of the reason for the increased risk is the loss of estrogen, which shifts fat from the hips to the midsection. Women close to menopause who experience sleep problems, night sweats, and mood issues may find that these symptoms interfere with eating a healthy diet or exercising.

Cutting back on calories is the most important way to counter increased weight after menopause. Other important tips for countering midlife weight include adding more vigorous exercises to your routine, eating your biggest meal at noon, not snacking too often, and doing stress-reducing activities like mindfulness or yoga to eliminate the need for that mood-mellowing pint of ice cream.